TCRN TCRN Shock and Resuscitation 4 — Questions and Answers
Question 1: Which class of hemorrhagic shock is characterized by 30-40% blood volume loss, confusion, and systolic BP of 90 mmHg?
- Class I
- Class II
- Class III (Correct answer)
- Class IV
Correct answer: Class III
Class III hemorrhage involves 30-40% blood volume loss (1,500-2,000 mL) with confusion, tachycardia, and systolic BP around 90 mmHg.
Question 2: A patient in septic shock requires norepinephrine. Which additional agent is recommended as a second-line vasopressor to reduce norepinephrine dosing?
- Epinephrine
- Vasopressin (Correct answer)
- Phenylephrine
- Dopamine
Correct answer: Vasopressin
Vasopressin (0.03-0.04 units/min) is added as a second-line vasopressor to septic shock management, allowing reduction of norepinephrine dose.
Question 3: During resuscitation of a trauma patient with hemorrhagic shock, which finding indicates successful resuscitation?
- Normalization of heart rate alone
- Rising base deficit worsening to -10
- Lactate clearance of >10% per hour (Correct answer)
- Persistent tachycardia with improving BP
Correct answer: Lactate clearance of >10% per hour
Lactate clearance of greater than 10% per hour indicates improved tissue perfusion and is a reliable marker of successful resuscitation.
Question 4: A trauma patient receives 10 units of PRBCs during massive transfusion. Which complication is specifically associated with this volume of transfusion?
- ARDS from hyperoxygenation
- Transfusion-associated circulatory overload (TACO) (Correct answer)
- Immediate hemolytic reaction
- Polycythemia
Correct answer: Transfusion-associated circulatory overload (TACO)
Massive transfusion increases risk of TACO, characterized by pulmonary edema, hypertension, and respiratory distress from volume overload.
Question 5: Which mechanism causes the 'paradoxical bradycardia' sometimes seen in severe hemorrhagic shock (Bezold-Jarisch reflex)?
- Vagal stimulation from an empty ventricle causing paradoxical slowing (Correct answer)
- Sympathetic overdrive causing AV node suppression
- Electrolyte imbalance from rapid fluid shifts
- Beta-receptor downregulation from catecholamine excess
Correct answer: Vagal stimulation from an empty ventricle causing paradoxical slowing
The Bezold-Jarisch reflex occurs when a near-empty left ventricle triggers vagal stimulation, paradoxically causing bradycardia in severe hemorrhage.
Question 6: A patient in cardiogenic shock post-trauma has a pulmonary artery occlusion pressure (PAOP) of 22 mmHg and cardiac index of 1.8 L/min/m². Which intervention is most appropriate?
- Aggressive IV fluid bolus
- Dobutamine infusion (Correct answer)
- Norepinephrine infusion
- Blood transfusion
Correct answer: Dobutamine infusion
Elevated PAOP with low cardiac index in cardiogenic shock indicates heart failure; dobutamine increases contractility without significantly increasing preload.
Question 7: Which acid-base disturbance is most commonly found in the early phase of hemorrhagic shock?
- Metabolic alkalosis
- Respiratory alkalosis
- Metabolic acidosis (Correct answer)
- Mixed respiratory and metabolic alkalosis
Correct answer: Metabolic acidosis
Hemorrhagic shock causes tissue hypoperfusion leading to anaerobic metabolism and lactic acid production, resulting in metabolic acidosis.
TCRN TCRN Shock and Resuscitation 4
Which class of hemorrhagic shock is characterized by 30-40% blood volume loss, confusion, and systolic BP of 90 mmHg?